May is Hepatitis Awareness Month in the United States, and May 19 is Hepatitis Testing Day. During May, the Centers for Disease Control and Prevention (CDC) and other public health organizations raise awareness of the “hidden epidemic” of viral hepatitis and encourage priority populations—such as baby boomers—to get tested.
But as of 2015, less than 13% of baby boomers in the United States have undergone screening for hepatitis C virus (HCV) infection; meanwhile, the incidence of liver cancer has steadily increased in recent decades. Chronic HCV infection affects up to 3.9 million people in the United States, and is the cause of almost half of all cases of liver cancer.
A recent study published in Cancer Epidemiology, Biomarkers & Prevention noted that baby boomers (those born 1945 to 1965) represent more than 75% of HCV-positive individuals in the United States. Both the CDC (in 2012) and the US Preventive Services Task Force (in 2013) recommended that this age group be screened for the virus.
For this study, lead author Monica Kasting, PhD, postdoctoral research fellow at the H. Lee Moffitt Cancer Center, Tampa, FL, and colleagues investigated whether HCV screening rates had increased following US Food and Drug Administration approval of several well-tolerated and effective treatments for HCV infection.
Using National Health Interview Survey data from 2013-2015, Dr. Kasting and colleagues analyzed HCV screening prevalence among four different age cohorts (those born before 1945, born 1945-1965, born 1966-1985, and born after 1985). Because the researchers were interested in assessing HCV screening in the general population, they excluded special populations who were more likely to have been screened for the virus, such as those with chronic liver conditions, history of liver cancer, or high self-reported alcohol use. The resulting total sample size was 85,210 participants.
Participants were asked if they had ever had a blood test for hepatitis C. Among baby boomers, HCV screening rates ranged from 11.5% to 12.8% between 2013 and 2015. The screening rate was only 3.9% to 4.5% in those born before 1945. The second youngest cohort (born 1966-1985) was screened at a similar rate as the baby boomers (13.7% to 14.9%).
In the final multivariable model, the odds of HCV screening increased significantly from 2013 to 2014 (odds ratio [OR] 1.20) and from 2013 to 2015 (OR 1.31). In every age group, females were screened less often than males (adjusted OR 0.71). Among baby boomers and the group born between 1966 and 1985, HCV screening rates were lower among Hispanics (adjusted OR 0.79) and non-Hispanic blacks (adjusted OR 0.81).
Less than 20% of baby boomers reported that their age was the reason for getting screened. Those more likely to get screened had seen a health-care provider in the past 12 months (adjusted OR 1.27), had ever been tested for HIV (adjusted OR 4.17), had their blood pressure checked in the past 12 months (adjusted OR 1.43), or had been screened for colon cancer in the past 12 months (adjusted OR 1.43).
“Hepatitis C is an interesting virus because people who develop a chronic infection remain asymptomatic for decades and don’t know they’re infected. Most of the baby boomers who screen positive for HCV infection were infected over 30 years ago, before the virus was identified,” said Dr Kasting.
The low screening rates among women, Hispanics, and blacks is concerning because these groups have higher rates of HCV infection and higher rates of advanced liver disease, which may reflect a disparity in access to screening, and therefore treatment, for an infection that is now highly curable with direct-acting antivirals.
According to study coauthor Anna Giuliano, PhD, founding director, Center for Infection Research in Cancer at Moffit Cancer Center, the most notable finding is that the HCV screening rate is increasing only incrementally. “Between 2013 and 2015, HCV screening only increased by 0.9% in the baby boomer population. Given rising rates of liver cancer and high HCV infection rates in this population, this is a critically important finding,” she said. “It shows that we have substantial room for improvement, and we need additional efforts to get this population screened and treated as a strategy to reduce rising rates of liver cancer in the United States.”
For more information and resources on Hepatitis Awareness Month, and what you can do to promote screening, visit the CDC’s site: Hepatitis Awareness Month and Hepatitis Testing Day.